Media drops the ball on the ACA; conservatives forget they love it; Paul Ryan is a very serious person....

The Washington Post is still having a hard time understanding Obamacare. It repeated the silliness about the exchanges needing young people to sign up. (The issue is health, not age, as we have been trying to explain to elite reporters for years.)A front page article on the political impact of Obamacare told readers:

"Still, Democrats may be disappointed if they expect the newly insured to emerge as a politically powerful constituency, as senior citizens did for Medicare. Robert J. Blendon, a professor of health policy and political analysis at the Harvard School of Public Health, said polls suggest that nine of 10 people who vote in midterm elections are insured. Thus, they are unlikely to benefit from the law."

This is not true. Just as tens of millions of people who file no claims in the course of a year benefit from having insurance, the people who already have insurance benefit from Obamacare. They now are in a situation where if they lose their job or decide to quit they will still be able to get insurance. That was not previously true, especially if a worker or someone in their family has a serious medical condition.

The political benefit of this ability to buy insurance outside of employment will depend on the extent to which people are aware of it. Insofar as major media outlets try to hide what is arguably the most important feature of Obamacare, it will not benefit the Democrats politically. However that is a function of media coverage of the law, not the law itself.

Lots of nonsense is floating about in regards to the ACA. Every Republican politician I know is against; and for all the things in the ACA that poll well with people. Fact is, it was the Republicans idea before a black guy in the White House was pragmatic enough to implement it conservative insurance reform rather than push for singlepayer. Obamacare is the replacement for the ACA if Republicans want to repeal and replace without creating a singlepayer system.

No, I haven’t lost my mind — or suddenly become an Ayn Rand disciple. It’s not my ideal; in a better world I’d call for single-payer, and a significant role for the government in directly providing care.

But Ross Douthat, in the course of realistically warning his fellow conservatives that Obamacare doesn’t seem to be collapsing, goes on to tell them that they’re going to have to come up with a serious alternative.

But Obamacare IS the conservative alternative, and not just because it was originally devised at the Heritage Foundation. It’s what a health-care system that does what even conservatives say they want, like making sure that people with preexisting conditions can get coverage, has to look like if it isn’t single-payer.

I don’t really think one more repetition of the logic will convince many people, but here we go again. Suppose you want preexisting conditions covered. Then you have to impose community rating — insurers must offer the same policies to people regardless of medical history. But just doing that causes a death spiral, because people wait until they’re sick to buy insurance. So you also have to have a mandate, requiring healthy people to join the risk pool. And to make buying insurance possible for people with lower incomes, you have to have subsidies.

And what you’ve just defined are the essentials of ObamaRomneyCare. It’s a three-legged stool that needs all three legs. If you want to cover preexisting conditions, you must have the mandate; if you want the mandate, you must have subsidies. If you think there’s some magic market-based solution that obviates the stuff conservatives don’t like while preserving the stuff they like, you’re deluding yourself.

What this means in practice is that any notion that Republicans will go beyond trying to sabotage the law and come up with an alternative is fantasy. Again, Obamacare is the conservative alternative, and you can’t move further right without doing no reform at all.

Nevertheless, on a similar note Paul Ryan is a very serious person because #urgleburgle....